鄂西北某院患者输血知识认知情况及教育需求分析

目的:调查综合性医院患者对安全输血的认知情况,以便有针对性地开展培训,降低风险。方法:自行设计问卷,调查185名患者对安全输血的认知程度和需求。结果:患者对涉及输血不良反应、自体输血等内容的认知相当欠缺。结论:应当持续性的患者进行安全输血知识培训,切实保障输血安全。     

Role of transfusion in stem cell transplantation: a freedom-from-transfusion (FFT), cost and survival analysis

Abstract

Background: Transfusion of blood products is often necessary for patients undergoing stem cell transplantation (SCT). The need for red cell and platelet transfusion may vary significantly depending on the type of transplantation and underlying disease.

Methods: In an attempt to evaluate the need and volume of transfusions in patients undergoing SCT at University of Kansas Medical Center, the authors retrospectively evaluated the transfusion data of all patients who received SCT between 2000 and 2005.

Results: A total of 138 (90%) out of 154 patients undergoing autologous SCT and 24 (43%) out of 56 patients with allogeneic SCT exhibited total hematopoietic engraftment and freedom from transfusion (FFT). Time to achieve FFT (median; range) for RBC units for autologous SCT (12; 0–183) was significantly shorter compared with allogeneic SCT (16.5; 0–373). Number of RBC units (median; range) transfused were significantly less in patients undergoing autologous SCT (4; 0–26) compared to patients undergoing allogeneic SCT (6.5; 0–54). The median cost of transfusion was significantly higher in patients undergoing allogeneic SCT (red cell: $2,015; platelet: $4,480) compared to patients undergoing autologous SCT (red cell: $1,240; platelet: $2,520). The authors recognize that this was a retrospective single-center study and practice guidelines may vary from center to center.

Conclusion: Authors conclude that transfusion of blood products is an expensive but integral part of SCT, more so for allogeneic SCT than for patients undergoing autologous SCT. Total FFT is a desirable long-term goal of successful marrow transplantation.     

水下隧道问题的边界元方法

文献[1][2]用有限元方法分别计算了水下单一隧道和双隧道的压力分布。本文用边界元方法计算了水下三隧道非对称情况下的压力分布及典型流场。计算结果符合物理规律。     

Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures

Aims: This study aimed to estimate the cost of platelet transfusion in patients with chronic liver disease (CLD)-associated thrombocytopenia undergoing an elective procedure in the United States.

Materials and methods: The study was conducted in two parts: development of a conceptual framework identifying direct, indirect and intangible costs of platelet transfusion, followed by the estimation of the total cost of platelet transfusion in patients with CLD-associated thrombocytopenia before an elective procedure in the United States using the conceptual framework and cost data obtained from a literature search. The cost of the entire care required to raise a patient’s platelet count before the procedure was considered.

Results: The final conceptual framework included the costs of generating the supply of platelets, the platelet transfusion itself, adverse events associated with platelet transfusion and refractoriness to platelet transfusion. When costs were accounted for in all the framework cost categories, the total direct cost of a platelet transfusion in a patient with CLD and associated thrombocytopenia was estimated to be in the range of $5258 to $13,117 (2017?US dollars) in the United States. The largest portion of costs was incurred by the transfusion event itself ($3723 to $4436) and the cost of refractoriness ($874 to $7578), which included the opportunity cost of a delayed procedure and subsequent platelet transfusions with human leukocyte antigen-matched platelets.

Limitations and conclusions: Although we were unable to include all cost components identified in the conceptual framework in our total cost estimate, thus likely underestimating the true total cost, and despite the data gaps and challenges limiting our estimate of the full cost of a platelet transfusion in patients with CLD-associated thrombocytopenia undergoing an elective procedure in the United States, this study outlines a comprehensive conceptual framework for estimating the cost elements of a platelet transfusion in these patients.     

红细胞输血无效相关影响因素分析

目的探讨影响红细胞输血无效的相关因素。方法选取我院2012年10月至2013年10月收治的1 280例红细胞输血患者的临床资料,对其临床资料进行回顾性分析,详细记录患者的年龄、性别、输血次数、原发症状、输血后的不良反应等,分析红细胞输血无效的相关影响因素。结果血液内科无效输血所占比例为20.2%,肝胆科无效输血所占比例为6.5%,比较差异有统计学意义(P<0.05)。输血次数越多、患者年龄越大,输血无效的可能性就越大。结论医院应注重观察患者的输血效果,一旦发现输血无效,要及时采取措施解决问题,确保临床出血工作的有序进行,做到合理使用血液资源,还可使患者负担减轻,保障临床疗效,提高患者的生活质量。     

我国社会救助造血机制及其立法完善

法治视野中社会救助方式是指通过法律创设一系列制度化规定,明确社会救助的供给主体与对象,并依靠制度建设与公共政策调整为社会弱势群体提供相应的救助服务的一种手段。确定社会救助方式的基本类型,是开展社会救助立法工作的先决条件。目前,我国社会救助制度采取以输血救助为主,造血救助为辅的救助模式。该模式救助水平有限,社会成本较高,社会效果不明显。因此,我国《社会救助法（征求意见稿）》在立法理念上应注重输血与造血两种救助方式的结合,突出造血救助的重要性,在制度层面上加强造血救助机制的立法完善。     

门诊输液室护士的职业危害与防范

门诊输液室病种复杂,工作量大,护士面临的职业危害更大。本文通过分析造成护理人员职业危害的各种危险因素,提出针对性防护措施,便于提高输液护士自我防护意识,减少职业危害发生率。     

The burden associated with thrombocytopenia and platelet transfusions among patients with chronic liver disease

Abstract

Background: Thrombocytopenia (TCP), a common complication of chronic liver disease (CLD), can cause uncontrolled bleeding during procedures. As such, CLD patients with TCP and platelet counts <50,000/μL often receive prophylactic platelet transfusions before invasive procedures. However, platelet transfusions are associated with clinical complications, which may result in increased healthcare utilization and costs.

Objective: This retrospective database analysis describes the clinical and economic burden in CLD patients with TCP, CLD patients without TCP, and CLD patients with TCP who receive platelet transfusions.

Methods: Adult CLD patients with or without TCP were identified in the IBM MarketScan Commercial Claims and Medicare Supplemental data from 1 January 2012 to 31 December 2015. CLD patients with or without TCP were propensity-score matched (1:1) for the analysis of annual healthcare utilization and costs. Platelet transfusions among CLD patients with TCP were identified using procedure codes.

Results: Of the 601,626 patients with CLD, 8,292 (1.4%) patients with TCP were matched to patients without TCP. Among CLD patients with TCP, 981 (11.8%) patients received ≥1 platelet transfusions and met inclusion/exclusion criteria. Compared to patients without TCP, CLD patients with TCP had more complications, including higher prevalence of neutropenia (11.4% vs 2.9%) and bleeding events (21.4% vs 10.9%), greater resource utilization including greater average hospital admissions (1.2 vs 0.7, p?<?.01), greater average ER visits (2.1 vs 1.3, p?<?.01), higher average outpatient office visits (20.1 vs 18.4, p?<?.01), and higher average healthcare costs including total costs (p?<?.01), inpatient costs (p?<?.01), ER visit costs (p?<?.01), and outpatient office visit costs (p?<?.01). The mean annual total costs in CLD and TCP patients with platelet transfusions were $206,396.

Conclusions: CLD patients with TCP, and particularly those who received platelet transfusions, experienced significantly greater clinical and economic burden compared to CLD patients without TCP. Safer and more cost-effective treatments to increase platelets are necessary.     

“输血”与“造血”的选择——对新疆农民增收问题的现实思考

新疆农民收入水平低、增长速度缓慢,而且城乡差距巨大。增加新疆农民收入,面,陆整体经济发展滞后、农民自身素质相对较低和二元结构三大困境;“输血”与“造血”是新疆农民增收短期作用与长效机制的必然选择,惟有加大“输血”和“造血”的力度,短期目标与长期计划相结合,资金、政策扶持与农民自身强化增收能力相结合,才有希望在农民增收上取得持续进展。